Journal of esthetic dentistry最新文献

Evidence-based clinical practice integrates the best available evidence with clinical expertise. This article presents a clinical case scenario and, using a four-step, evidence-based approach, demonstrates how to (1) ask an evidence-based question; (2) search MEDLINE for the best evidence; (3) critically appraise the evidence; and (4) apply the evidence to the patient. The procedure is demonstrated with the sample question, Does bleaching of bonded porcelain veneers increase marginal leakage? A MEDLINE search strategy was developed for synonyms of the key words that best identify the problem, the intervention, and the outcome. The synonyms were combined using the Boolean operator "or" to identify a "sensitive" (i.e., inclusive) universe of 140,000 journal articles. These categories were then combined using the Boolean operator "and" to identify the most "specific" (i.e., exclusive) four articles from among the 140,000. Finally, to find the best evidence, the articles were limited to "humans" and "randomized controlled trials." This identified one article. Critical appraisal of the limited data in this one article indicates that the methods are valid and statistically significant, but because of the methods employed, may not be clinically important. Evidence-based methods take one to the edge of the available information universe in about 15 minutes. The results can be both exhilarating and sobering. They can indicate the depth or limits of available information and suggest gaps in the knowledge-base that require further study. Most importantly, however, the results allow practitioners to communicate incisively and truthfully with patients and to make more informed clinical choices.

Inadequate saliva can have devastating consequences for a patient, including oral discomfort, rampant caries, increased candida infections, and desiccation of restorative and esthetic dental treatment. Diagnosis of the cause of xerostomia is imperative to treating the condition, and multiple causes should be considered. Treatment options for xerostomia consists of treatment for hyposalivation, palliative and preventive care to combat the results of long-term dry mouth. Treatment of xerostomia should be based on the etiologic factors of the disease, with prevention of further oral destruction and comfort being the primary goals of treatment.

Composite materials have become an integral part of the wide range of filling materials currently available. Conditioning is necessary to achieve adequate bonding of the composite material to enamel and dentin. Normally, this is done by applying acid preparations to the dental surfaces. These acids have an etching effect that causes surface roughening. The increasing application of lasers in dentistry has introduced another possibility. Laser irradiation can cause roughening of enamel and dentin surfaces. Another interesting alternative is the so-called kinetic cavity preparation technique. This method also results in distinct surface roughening. The purpose of the present study, was to compare the described methods. Tensile bond strength tests and shear bond tests were carried out to examine the adhesion of a composite material to surfaces treated with these methods. Laser irradiation with certain devices and the air-abrasive technique yielded results similar to those with acid etching.

Restoring splinted mandibular incisors and canines with full crown restorations has always presented a challenge in creating an esthetic illusion of reality of normal individual teeth. This treatise is designed to present the rules for mandibular anterior esthetics that have been distilled from almost 4 decades of clinical practice of restoring dentitions that have been severely compromised by the deformities of disease or accident. The resultant formula systematically creates the desired results with a high degree of predictability.

Older adults present special problems for the dentist trying to establish or reestablish esthetics. Periodontal diseases are of concern for this population since tooth loss from these widespread problems increases with age. In general, this loss occurs because of increased exposure time to pathogenic bacteria, not some change inherent in the body brought on by the aging process. The profession has begun to place more emphasis on systemic risk factors and their role in modifying periodontal inflammation. The current thinking is that bacteria are necessary to initiate and sustain periodontal diseases, but the clinical manifestation is dictated to a significant extent by systemic factors. Smoking, diabetes, and being positive for the interleukin-1 genotype predispose the patient to developing more severe disease. For those older adults who lose teeth, dental implants have emerged as reliable replacements, and concerns about placing these devices in patients who have lost teeth as a result of periodontitis appear to be largely unfounded.

A number of facial altering surgical procedures have been presented. Several areas are important to note. Most of these procedures were devised by practitioners lost to antiquity and individuals in a plethora of different fields, including orthopedics, dermatology, oral surgery, plastic surgery, and otolaryngology. Just as in the other specialties that perform these procedures, not all surgeons of the specialties perform the entire scope of their specialty. However, dentistry now has the capability to change the jaws, soft tissue drape of the face, neck, nose, and eyes, as well as smile lines and the shape and color of the dentition. No other profession in the history of human-kind has ever had this potential to make such facial changes.

The type of communication described makes up a kind of three-dimensional pretreatment communication that leads to greater patient satisfaction and helps to reduce the likelihood of lawsuits from patients who feel that they were promised results that were not met. The method of try-in veneers allows the patient be a part of the outcome in the pretreatment stages. This can lead to a happier, more satisfied patient, which is what all practitioners strive to obtain.